Concurrent benzodiazepine use in older adults treated with antidepressants in Asia

Zhong, Xiao Mei; Wang, Fei; Zhang, Qinge; Ungvári, Gábor S.; Ng, Chee H.; Chiu, Helen F.K.; Tian, Mei; Sim, Kang; Grover, Sandeep; Chong, Mian Yoon; Chee, Kok Yoon; Kanba, Shigenobu; Lee, Min Soo; Yang, Shu Yu; Udomratn, Pichet; Kallivayalil, Roy Abraham; Tanra, Andi Jayalangkara; Maramis, Margarita Maria; Shen, Winston W.; Sartorius, Norman; Mahendran, Rathi; Tan, Chay Hoon; Shinfuku, Naotaka; Xiang, Yu Tao

doi:10.1017/s1041610217002563

Cited by 9 publications

(6 citation statements)

References 31 publications

(32 reference statements)

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“…Our study showed that 54.9% (before PS matching) of adults with incident depression received AD+BZD therapy, which was comparable to those (40-50%) in previous studies on other Asian [31,32] or Caucasian populations [33]. While the clinical manifestation of depression in Korean patients could have been different from that of patients of other countries, cultures, or ethnicities [34], we found similar proportions of AD+BZD use among patients with depression.…”

Section: Discussionsupporting

confidence: 83%

Risk of mortality associated with concomitant antidepressant and benzodiazepine therapy among patients with depression: a population-based cohort study

Jeong

Jeon

et al. 2020

BMC Med

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Background With antidepressants (ADs) having minimal therapeutic effects during the initial weeks of treatment, benzodiazepines (BZDs) are concomitantly used to alleviate depressive symptoms of insomnia or anxiety. However, with mortality risks associated with this concomitant use yet to be examined, it remains unclear as to whether this concomitant therapy offers any benefits in treating depression. Methods We conducted a population-based cohort study using South Korea’s nationwide healthcare database from 2002 to 2017. Of 2.6 million patients with depression, we identified 612,729 patients with incident depression and newly prescribed ADs or BZDs, by excluding those with a record of diagnosis or prescription within the 2 years prior to their incident diagnosis. We classified our study cohort into two discrete groups depending on the type of AD treatment received within 6 months of incident diagnosis—AD monotherapy and AD plus BZD (AD+BZD) therapy. We matched our study cohort in a 1:1 ratio using propensity scores to balance baseline characteristics and obtain comparability among groups. The primary outcome was all-cause mortality, and patients were followed until the earliest of outcome occurrence or end of the study period. We conducted multivariable Cox proportional hazards regression analysis to estimate adjusted hazards ratios (HRs) with 95% confidence intervals (CIs) for the risk of mortality associated with AD+BZD therapy versus AD monotherapy. Results The propensity score-matched cohort had 519,780 patients with 259,890 patients in each group, where all baseline characteristics were well-balanced between the two groups. Compared to AD monotherapy, AD+BZD therapy was associated with an increased risk of all-cause mortality (adjusted HR, 1.04; 95% CI, 1.02 to 1.06). Conclusions Concomitantly initiating BZDs with ADs was associated with a moderately increased risk of mortality. Clinicians should therefore exercise caution when deciding to co-prescribe BZDs with ADs in treating depression, as associated risks were observed.

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Section: Discussionsupporting

confidence: 83%

Risk of mortality associated with concomitant antidepressant and benzodiazepine therapy among patients with depression: a population-based cohort study

Jeong

Jeon

et al. 2020

BMC Med

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“…Other research foci include psychiatric management patterns (Abdul Khaiyom, Mukhtar, & Oei, 2019; Dong et al, 2019; S.‐C. Park, Oh, et al, 2019; Zhong et al, 2019), electroconvulsive therapy, validations of translated scales (C.‐S. Ang, 2020; Cheung, Yeo, Chong, Khoo, & Wee, 2019; Din et al, 2019; Khairani, Ahmad, Ismail, & Aman, 2020; N. T. P. Pang, Kamu, et al, 2020), stigma (Ibrahim, Amit, et al, 2019; Sun et al, 2019) and child and adolescent psychiatry (Adib et al, 2019a, 2019b; A. L. Ang, Wahab, Abd Rahman, Hazmi, & Md Yusoff, 2019; Chhoa et al, 2019; Ibrahim, Amit, et al, 2019; Ibrahim, Che Din, et al, 2019; Ramachandram, 2019).…”

Section: Methodsmentioning

confidence: 99%

The state of psychiatric research in the Asia Pacific region

Roche

Fung

Ransing

et al. 2020

Asia-Pacific Psychiatry

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Introduction This study aims to review recent scientific publications and research output in the field of psychiatry, from a series of countries in the Asia‐Pacific region (Australia, India, Indonesia, Iran, Lebanon, Malaysia, and Nepal), with a view to identify themes and similarities across regions, as well as to examine the barriers and challenges in mental health research faced by countries in the region. Methods Seven psychiatrists from seven countries reviewed recent published and ongoing research in psychiatry in their respective nations, with respect to themes, as well as any barriers or challenges faced by mental health researchers. Results While the seven nations included in this review vary in terms of research capabilities and economic development level, they share many similarities both in terms of research direction, and with regards to challenges faced. Limitations in the form of sociocultural differences from the West, and a lack of funding were some of the barriers identified. Discussion Mental health research in the region has been progressing well. However, more varied research in the form of qualitative or economic studies are lacking, as are multi‐center studies. The similar issues that nations face with regards to research could perhaps benefit from collaborative efforts and initiatives for the furtherance of research in the region.

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“…The Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP‐AD) project is an international, multicentre survey on the use of ADs, which was conducted between March and June 2013 in 42 centres and hospitals in 10 Asian territories and countries, including China, Malaysia, Hong Kong, India, Indonesia, Japan, Thailand, Korea, Singapore and Taiwan. Patients with any mental disorder treated with ADs on the day of data collection were consecutively screened and enrolled in the survey.…”

Section: Methodsmentioning

confidence: 99%

Concurrent antipsychotic use in older adults treated with antidepressants in Asia

et al. 2019

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Aim Depressive disorders are common in old age. Antipsychotics (APs) are often used as an adjunctive treatment with antidepressants (ADs) in this population but its patterns of use in Asia are not known. This study explored the rate of combination of APs and ADs in older adult psychiatric patients in Asia. Methods This is a secondary analysis of the database of a multicentre study which recorded participants’ basic demographical and clinical data in standardised format in 10 Asian countries and territories. The data were analysed using univariate and multivariate logistic regression analyses. Results A total of 955 older adult psychiatric in‐ and outpatients were included in this study. The proportion of concurrent AP and AD use was 32.0%, ranging from 23.3% in Korea to 44.0% in Taiwan. Multivariate logistic regression analysis found that younger age, inpatient status and diagnosis of schizophrenia, anxiety and other mental disorders were significantly related to a higher proportion of concurrent use of APs and ADs. Conclusion Around a third of older adult psychiatric patients had concurrent AP and AD use in the Asian countries/regions surveyed. Considering the uncertain effectiveness and questionable safety of the AP and AD combination in this patient population, such should be cautiously used.

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Concurrent benzodiazepine use in older adults treated with antidepressants in Asia

Abstract: Nearly, half of the older adults treated with antidepressants in Asia are prescribed concurrent benzodiazepines. Given the potentially adverse effects of benzodiazepines, the rationale of benzodiazepines and antidepressants co-prescription needs to be revisited.

Cited by 9 publications

References 31 publications

Risk of mortality associated with concomitant antidepressant and benzodiazepine therapy among patients with depression: a population-based cohort study

Risk of mortality associated with concomitant antidepressant and benzodiazepine therapy among patients with depression: a population-based cohort study

The state of psychiatric research in the Asia Pacific region

Concurrent antipsychotic use in older adults treated with antidepressants in Asia

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